Following a diabetes-friendly eating plan can feel overwhelming, particularly when you’re first diagnosed. But whether you’re tweaking the way you eat for a couple weeks or you've been on a plan for 20 years, it's natural to crave foods you’re not supposed to be having. A diabetes diagnosis doesn’t mean you must forever cut yourself off from all restaurant meals, your favorite snacks, or the occasional dessert.
“People with diabetes don’t need to avoid their favorite foods,” says Grace DeRocha, RD, CDCES, who is based in Detroit. “Focus on being more intentional with your food choices, not restricted.”
Instead of labeling splurge meals and snacks as cheating, DeRocha says to flip the script: Focus on how to make fun foods fit into your plan in a balanced, positive way. Here’s how to get started.
What Happens When You Splurge
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Foods that have historically been considered splurges tend to be higher incarbohydratesandfat, such as pizza, desserts, burgers and fries, and snacks like potato chips.
“When someone with diabetes eats a large meal that’s high in carbohydrates, blood sugar levels typically rise as those carbohydrates are broken down into glucose and absorbed into the bloodstream,” says Amy Kimberlain, RDN, CDCES, founder of Amy’s Nutrition Kitchen in Miami.
When you have diabetes, your body doesn’t produce enough insulin or can’t use it efficiently, allowing blood sugar to rise higher or stay elevated longer, Kimberlain explains. This can mean that you stay out of the blood sugar range recommended by your physician.
These very high blood sugar levels can have unwelcome effects on both your short- and long-term health. If you feel lethargic or mentally slower after a big meal, it’s not just the amount of food in your belly: Symptoms like brain fog and food coma may be a result of your glucose levels skyrocketing. Wild glucose swings may also have an especially bad effect on your long-term diabetes health and management, leading to chronic inflammation and blood vessel damage.
“This is why portion size, meal composition, and timing — along with medications or insulin when prescribed — all play a role in helping manage blood sugar after meals,” Kimberlain says. The following strategies can help you do just that.
Pair Carbs With Protein and Fibre
If you’re thinking about having a carb-heavy meal or snack, DeRocha recommends pairing higher carb foods with foods that also contain protein or fiber. So if you want a slice of pizza, eat it with a side salad instead of garlic knots. For pasta, cook a whole-grain variety with lean protein (such as chicken or shrimp) and fiber-filled veggies. Even eating dessert after a balanced meal is more blood-sugar friendly than eating it on an empty stomach.
“Fiber and protein slow down the digestive process,” says DeRocha, which can help lessen a blood sugar spike and help keep you within a normal blood sugar range. Plus, this strategy can mean you’re adding more food to a higher carb meal — rather than taking away from it — which can be a positive mental shift, she says.
Pay Attention to Portion Sizes
Smaller portions of any food — including more indulgent ones — contain fewer carbohydrates, which helps lower its impact on your blood sugar, says Kimberlain. Keep carbs in check by ordering a kid-sized ice cream cone, boxing up half your pasta entreé to take home, or ordering a side of pancakes with a veggie-filled omelet rather than a full stack.
Kimberlain also recommends looking at carbohydrate portions across an entire meal. For example, if you’re craving dessert, skip the bread you may normally serve with a piece of lean protein and a side of vegetables.
Consider Cheat Meal Timing
It’s not just what you eat — when you consume guilty-pleasure foods has a big impact on your blood sugar levels, too.
“Some people find it helpful to enjoy these types of meals earlier in the day when they’re more likely to be active afterward,” says Kimberlain.
If you’re heading to an office party where you know you’ll indulge in the spread, consider building a 10- to 15-minute walk into your schedule afterward.
“Walking after eating has been shown in multiple studies to slow postmeal blood sugar,” says DeRocha. Physical activity triggers muscles to use up some of the glucose in your bloodstream, helping to reduce a blood sugar spike.
Check Your Blood Sugar Levels
It’s important to check your blood sugar levels regularly no matter what you’re eating, particularly if you have type 1 diabetes, since insulin needs can change quickly based on food, activity, and other factors. A continuous glucose monitor can track blood sugar levels 24 hours a day via a small sensor inserted under the skin that transmits real-time data to a smartphone or wearable device.
Even if you don’t wear a monitor, your doctor may recommend a schedule for checking your blood sugar. A regular schedule might include checking when you wake up, before a meal, two hours after a meal, and at bedtime.
Staying in tune to how your body reacts to food can help you figure out how and when to enjoy indulgent foods in the way that works best for you, says Kimberlain.
“Keep in mind that what works for you might not work for someone else,” she says. “Nutrition in diabetes management is so individualized.”
Don’t Let One Splurge Ruin Your Diet
Don’t be too hard on yourself if you go off your plan with a snack or meal. However you define a cheat meal, higher-carb food choices don’t need to automatically come with guilt or shame.
“I often remind people that diabetes management isn’t about perfection — it’s about patterns over time,” says Kimberlain. “Everyone has meals that are a little more indulgent or don’t go exactly as planned, and those moments don’t mean you’ve failed or ruined anything.”
Embrace your failures and low points: The splurges you couldn’t resist can help inform your future habits. “I encourage people to approach those situations with curiosity,” says Kimberlain, who recommends asking yourself the following questions the next time this comes up:
What did I enjoy?
How did my blood sugar respond?
Is there anything I’d do differently next time?
Kimberlain notes that learning from your own behavioral patterns makes healthy eating more sustainable. By prioritizing realism over restriction, you're more likely to achieve long-term success.
Be Cautious With Insulin
If you’ve been prescribed rapid mealtime insulin, it makes cheat meals a bit more complicated. Using insulin before every meal shouldn’t eliminate your flexibility, but it does mean you’ll want to think ahead. Higher-carb meals often require more precise timing and dosing, leaving less room for error when it comes to keeping blood sugar levels steady.
Kimberlain says that people who take insulin should always follow the dietary plan recommended by your doctor. The more carbs you eat at any one meal, the more insulin you’ll need to take, which only increases the risk of low blood sugar levels (hypoglycemia). It’s easy to give yourself too much insulin or too little, or even to give yourself the right amount but get the timing wrong.
If you take mealtime insulin, DeRocha recommends counting your carbohydrates as accurately as possible, talking to your doctor about your insulin-to-carb ratio for accurate dosing, and taking fast-acting insulin 15 minutes before your meal (so it can start working in a timely manner).
You should also be especially careful of other factors that can affect your sensitivity to insulin in the hours before and after your meal, such as alcohol, sleep patterns, and exercise.
The Takeaway
It’s natural to want to splurge and eat carb-heavy and fatty foods from time to time. If you’re living with diabetes, moderation may be the best strategy and may even help with long-term dietary success, since it prioritizes realism over restriction.
Rich high-carb foods like pizza, burgers, fries, and desserts can cause significant blood sugar spikes and physical lethargy, and they also contribute to your long-term health risks.
To splurge safely, pair carbohydrates with protein or fiber to slow digestion, choose smaller portions, and exercise after eating to help your body more efficiently process glucose.
People who use mealtime insulin should plan their splurges ahead so they’re able to monitor and manage their blood sugar levels after the meal.
Researcher offers insights on the related advantages, barriers and risks
Roughly one in eight Americans has type 2 diabetes – totalling over 40 million individuals, with an additional two million Americans with type 1 diabetes. In addition to the lifestyle and health impacts, the condition carries a heavy financial burden of a 2.5 times higher cost of living compared to someone without diabetes.
One step can vastly improve – and even prevent – negative diabetes outcomes and costs: exercise.
In the following Q&A, Zahalka details how exercise reduces the chances of getting type 2 diabetes and helps patients with both type 1 and type 2 diabetes with their overall health. She also talks about the barriers to exercise and any risks to be aware of when starting a routine.
Can exercise prevent type 2 diabetes?
Exercise is a great tool for preventing type 2 diabetes. Studies have shown that even small changes in peoples’ physical activity levels can lead to decreased rates of type 2 diabetes, so every movement matters.
In a study of the Diabetes Prevention Program – a Center for Disease Control and Prevention lifestyle change program that enrols people who are at high risk of developing diabetes – participants who achieved 150 minutes of moderate intensity activity per week had a 44% reduction in diabetes development.
What is one main obstacle to exercise for both patients with type 1 and type 2 diabetes? How can those obstacles be overcome?
One major obstacle to exercise can be exercise-induced hypoglycaemia, or low blood sugar. This is a common challenge for people with type 1 diabetes and for people with type 2 diabetes who are on certain glucose-lowering medications such as insulin. Different exercises can affect blood sugars differently, and these effects are not only experienced for the duration of the activity or what we call the “bout” of exercise, but also for up to 48 hours afterward in what we call the “post-bout” period.
One area of interest in exercise and diabetes research is to evaluate whether the specific order of performing exercises – such as resistance exercise followed by aerobic exercise – can help decrease low blood sugars. It is important that people living with diabetes discuss their exercise regimens with their diabetes providers as we have many individualized strategies to help prevent these low blood sugars and support each person’s exercise journey.
What are the benefits?
Many benefits are associated with regular exercise for people living with diabetes or who are at risk for diabetes. Some of these benefits are a reduction in blood pressure, an improvement in insulin sensitivity and glucose levels, prevention and minimization of weight gain, improvement in cholesterol levels and a reduction in rates of death from cardiovascular disease. This last benefit is particularly important because people with diabetes have a higher risk of bad outcomes from cardiovascular disease. We know that if we help people to improve their cardiorespiratory fitness (ability to exercise) we can decrease mortality.
Are there any dangers around exercise for those with diabetes?
Consistent exercise is associated with a reduction in cardiovascular risk. However, sudden exercise can be a cardiovascular stressor and, in susceptible individuals, may be associated with cardiovascular events. If someone with diabetes is just starting out on their exercise journey, it may be a safer and more effective strategy to start with being consistent with a low-intensity exercise and work up to higher intensity rather than being more sporadic with a high-intensity exercise.
Additionally, people with diabetes can have decreased sensation and blood flow to their feet, which puts them at higher risk for trauma to their feet from weight-bearing exercises. These are both important reasons for people with diabetes to discuss exercise programs with their providers so that they can assess their individual risks and help safely support their exercise.
What types of exercise – and their frequency – have been shown to be beneficial?
Both aerobic (running, jogging, brisk walking, swimming, cycling) and resistance (weights, resistance bands, body weight exercises) exercise regimens have been shown to help prevent type 2 diabetes and improve outcomes in people with diabetes.
An optimal modality and frequency of exercise have not been established, but the American Diabetes Association recommends that most adults with type 1 or type 2 diabetes engage in at least 150 minutes of moderate-to-vigorous-intensity aerobic activity and two to three sessions of resistance exercise per week.
The intensity of an aerobic activity can be defined by the amount of oxygen used by the body during that activity. One metabolic equivalent (MET) is the amount of oxygen (O2) used while at rest/sitting still, which is 3.5 millilitres O2 per kilogram of body weight per minute. Physical activities that burn 3.0 to 5.9 METs are considered moderate intensity, and those that burn 6.0 METs or more are considered vigorous intensity.
Brisk walking usually falls into the moderate-intensity MET category and running falls into the vigorous category.
What are “non-responders” and how can they still use exercise to help their health?
The term “non-responders” is used to describe people who do not get certain anticipated benefits of exercise, such as improved glucose or blood pressure. However, the good news is that even if a specific benefit isn’t achieved from exercise therapy, other benefits are often attained. For example, if someone’s blood sugars are unchanged by exercise, they may gain increased cardiorespiratory fitness. Sometimes, the lack of “response” may also be due to the type of exercise (aerobic vs. resistance) or the timing of exercise, and that is why to achieve someone’s desired benefits from exercise an individualized approach is key.
What is GLUT4 and how does it translate into exercise being a positive step for diabetes?
GLUT4, a glucose transporter that insulin stimulates to bring glucose inside the cell, is also stimulated by muscle contraction during exercise without insulin. This increases transport of glucose into muscle cells and is one way that exercise can acutely decrease blood sugar levels even when someone has insulin resistance or does not produce insulin.
What is some ongoing clinical research underway on campus on this topic?
My colleagues Drs. Jane Reusch and Judy Regensteiner are conducting an NIH study to understand how exercise training improves cardiac and skeletal muscle function in adults with and without type 2 diabetes. They are currently seeking volunteers who are not exercising and not on certain types of diabetes medications, such as SGLT2 inhibitors or GLP-1 receptor agonists. In this study, people can learn a lot about the function of their heart, skeletal muscle and blood vessels and receive an individualized exercise program.
Type 5 diabetes is rarely discussed or researched, and yet it is thought to impact up to 25 million people worldwide, especially those in low- and middle-income nations where access to medical care is limited.
It was first described in 1955 in Jamaica, then forgotten about for many years. Even once it was acknowledged by the WHO in the 1980s, the diagnosis created controversy.
For going on seven decades, scientists havedebatedwhether type 5 diabetes exists at all, and in 1999, WHO withdrew the classification due to a lack of evidence. There has been little agreement on how to diagnose type 5 diabetes or how to treat it.
(Nataliya Vaitkevich/Pexels/Canva)
Type 1 diabetes is an autoimmune condition that destroys the pancreas's ability to produce insulin. Type 2 diabetes is an insensitivity to insulin due to diet and lifestyle. Type 3c diabetes is commonly caused by damage to the pancreas. Gestational diabetes is triggered by hormonal changes during pregnancy.
Type 5 diabetes seems to stem from nutrient deficiency. Previously known as malnutrition-related diabetes mellitus (MRDM), this form of diabetes is commonly misdiagnosed as other types.
And yet, because insulin resistance does not seem to be the primary cause of type 5 diabetes,existing treatmentsmay not help. In fact, theymay even harm.
"Understanding the specific types of diabetes someone has is crucial to providing the right treatment," Craig Beall, a diabetes researcher at the University of Exeter, explained in May 2025.
For years now, Meredith Hawkins, an endocrinologist at the Albert Einstein College of Medicine's Global Diabetes Institute, has called for global recognition of type 5 diabetes, which typically impacts people in Asia and Africa who are experiencing severe food insecurity.
"Malnutrition-related diabetes is more common than tuberculosis and nearly as common as HIV/ AIDS, but the lack of an official name has hindered efforts to diagnose patients or find effective therapies," Hawkins said in 2025.
"I'm hopeful that this formal recognition as type 5 diabetes will lead to progress against this long-neglected disease that severely debilitates people and is often fatal."
The pancreas produces insulin, which helps cells absorb glucose from the blood. (Science Photo Library/Canva)
Hawkins' own work, published in 2022, was the first to establish a unique metabolic profile for this with malnutrition-related diabetes.
She and her colleagues ran a small trial in south India, which showed people with MRDM are insulin-deficient like people with type 1 diabetes, but not to the same degree, and still sensitive to insulin, unlike people with type 2 diabetes who develop resistance.
"Type 5 diabetes stands apart with its unique pathogenesis, theorized to involve compromised pancreatic development resulting from extended periods of nutritional insufficiency," Rahul Garg, a physician at F.H. Medical College and Hospital in India, wrote in a recent review.
In light of this evidence, the IDF is making a concerted effort to at last recognize type 5 diabetes.
Some researchers have said the move is "long overdue", while others argue that it is "unwarranted" due to "diagnostic uncertainty" stemming from the variety of diabetes cases seemingly related to malnutrition.
Some say the number of patients with type 5 diabetes is growing; others say its prevalence is receding. Either way, it's all tied up in whether the condition is properly diagnosed and recognized.
Without a formal name and recognition, it's challenging to fund research, and without further evidence, it's impossible to know enough about a condition to formulate a standard diagnosis or to say how many people it affects.
In 2025, the IDF established a type 5 diabetes working group, with Hawkins as chair, to develop formal diagnostic criteria and therapeutic guidelines for type 5 diabetes; establish a global research registry; and create training for healthcare professionals.
The distinct metabolic profile of type 5 diabetes means treating doctors need to tread a fine line when managing patients' insulin levels.
People with type 5 diabetes might only need minimal amounts of supplementary insulin or require alternative approaches to stimulate insulin secretion, to avoid insulin levels plummeting or spiking dangerously.
Undernutrition in infancy and early childhood can lead to diabetes. (Wadivkar et al., The Lancet Global Health, 2025)
"Inappropriate insulin treatment could induce hypoglycaemia [low blood sugar levels], which can be a particular risk in settings with food insecurity and where glucose monitoring might not be affordable," Hawkins and colleagues explained, in a review published after type 5 diabetes was formally recognized.
The issue isn't confined to Asia and Africa, either. Undernourishment is a growing problem in parts of Latin America and the Caribbean, where a complicated mix of environmental, political, and economic factors is magnifying health inequalities and extreme poverty.
"There is no quick fix, and so we expect the fight against this disease to require substantial further research and advocacy,"saidHawkins in an interview.
"Once you have seen young patients dying from inappropriate treatment of a neglected form of diabetes, there's no turning back."
